Deep Venous Valve Research Articles

Anatomy and pathophysiology of varicose veins.

The venous anatomy of the leg is described with special reference to the superficial venous system. The histologic and histochemical differences between varicose and normal veins are presented. The pathophysiology of varicose veins is related to congential or acquired abnormalities of the deep venous system, venous valves, and/or fascial or vein wall weakness. Increased deep venous pressure may be both proximal and distal in etiology, arising from arteriovenous anastomoses, incompetent communicating veins, or venous obstruction. Primary valvular incompetence arises from venous obstruction (thrombosis), thrombophlebitis, or valvular agenesis. Secondary valvular incompetence occurs from deep venous obstruction or increased venous distensibility (usually secondary to circulating estrogens). Finally, fascial weakness of the vein wall or supporting fascia provided a genetic basis for the pathophysiology of varicose veins. Understanding the anatomy and pathophysiology of varicose veins should lead to a more rational and efficacious treatment.

DEEP VENOUS VALVES IN THE ÆTIOLOGY OF VARICOSE VEINS

DEEP VENOUS VALVES IN THE ÆTIOLOGY OF VARICOSE VEINS

Newer surgery of the heart and large vessels: Medical aspects: Marvin, H. M.: Bull. New York Acad. Med. 17: 737, 1941

Purpose: To evaluate the results of axillary vein to popliteal vein valve transplantation (VVTX), we reviewed the clinical, phlebographic, and noninvasive hemodynamic results in 15 patients.Methods: All patients had postthrombotic destruction of deep venous valves as determined by ascending phlebography, whereas descending phlebography demonstrated grade III or IV reflux in all patients. A segment of valve-bearing axillary vein was transplanted to the popliteal vein in the affected limb. Postoperative evaluation was by clinical, noninvasive, and phlebographic means.Results: Over a mean follow-up period of 5.3 years (1.25 to 11 years), 13 of 14 patients (93%) had symptomatic improvement with relief of swelling, whereas all 14 patients who were admitted with pain had relief after operation. Thirteen of 15 patients (87%) returned to work or household duties. Physical findings of edema, skin pigmentation, and lipodermatosclerosis improved in most patients. Only three patients (21%) had development of recurrent ulcers, with an average postoperative ulcer-free interval of 4 years by life-table analysis. The cumulative ulcer-free survival rate for the group averaged 62% at late follow-up. All three patients with ulcer recurrence had a functioning valve by descending phlebography, but recurrent perforating veins were found in two patients, and deep venous thrombosis above a patent VVTX was observed in the third. Late assessment of reflux by venous filling index and valve closure times for the entire sample demonstrated mean values of 4.9 seconds in the latter and 6.8 ml/sec in the former. Residual volume fraction, which correlates with invasive ambulatory venous pressures, was reduced to a mean of 31%. No deterioration in late sequential noninvasive values could be detected.Conclusion: VVTX is a durable procedure for preventing recurrent venous ulcers. (J V ASC S URG 1995;21:110-9.)